Dr. Skokan graduated cum laude from the University of Notre Dame in 1987; received her medical degree at Oregon Health Sciences University in 1992; was awarded a fellowship position in the University of Utah Department of Pediatrics' Pediatric Emergency Medicine Fellowship Program; she obtained a masters in public health degree in 1999 from the University of Utah. Dr. Skokan is both well prepared and qualified for a K award in mentored patient-oriented research. As part of her proposed career development plan, she will develop expertise with (1) the use of population-based databases, (2) methodology used to probabilistically link such databases, (3) advanced statistics necessary for longitudinal data analyses, and (4) ability to coordinate interventions in the emergency department and assess their efficacy. Dr. Skokan will also pursue additional training in the complexities unique to child maltreatment research. Child maltreatment is a leading cause of death in children. Credible evidence suggests that many children who ultimately die as the result of child maltreatment are seen by health care providers prior to their demise. The overall hypothesis of this research proposal is that earlier diagnosis and intervention leads to decreased morbidity and mortality for victims of child maltreatment. This project has three specific aims. The first is to measure the frequency of facility-based health care visits that child maltreatment victims have prior to an accurate diagnosis of abuse being made. A case control experimental design using large population-based databases will be used for this study. State-wide emergency department, inpatient, and EMS databases will be probabilistically linked to the databases for the Division of Child and Family Services and Vital Statistics to provide a comprehensive assessment of the patterns of health care utilization by abused children prior to the injury or sentinel event that results in a diagnosis of child maltreatment. The second specific aim is to conduct a longitudinal study, prospectively comparing patient mortality, morbidity, and behavioral measures of child maltreatment victims who had delayed recognition and victims with prompt recognition of abuse or neglect. The third specific aim is to prospectively implement and evaluate the impact of a structured educational program for emergency medical health care providers to improve comfort with and documentation of the diagnosis of physical child abuse.